Abstract
Introduction:
With the increased application of the implants for the restoration of the lost teeth, the peri-implantitis cases are seen on a rise. Hence, we conducted a study retrospectively to evaluate, among the peri-implantitis cases, the success of the soft-tissue grafting.
Material and Methods:
We piloted a retrospective study among 50 subjects of both genders who underwent the soft-tissue grafting for the treatment of the peri-implantitis of a total of 69 implants. The clinical parameters noted were at the baseline and at various years of follow-ups. The data of the clinical parameters were noted, and the data thus noted were compared deliberating P < 0.05 as significant.
Results:
Thin soft-tissue biotype was noted among all the subjects, with the increased width of the keratinized mucosa. Significant lowering of the probing depth, bleeding on probing, and the mobility of the tissue were noted.
Conclusions:
We can conclude that soft-tissue grafting Is a benificial method for the peri-implantitis treatment.
KEYWORDS: Bleeding on probing, keratinized mucosa, peri-implantitis, soft-tissue grafts
INTRODUCTION
The rehabilitation and the restoration of the lost teeth with the dental implants have increased in the last decade. Although there are many advantages for the implantation and the survival, the number of the cases impacted with the peri-implantitis has increased.[1] The success of the implants and the incidence of the peri-implantitis are comparable.[2,3] There are many factors that are implicated in peri-implantitis.[4] The peri-implantitis may be treated by the surgical and the nonsurgical modalities.[5,6] Ignoring the biological considerations when placing the implants is deemed to be a chief source for the peri-implantitis. The role of the soft-tissue grafting in the treatment of the peri-implantitis is debated. Hence, in our study, we aimed a study retrospectively to evaluate, among the peri-implantitis cases, the success of the soft-tissue grafting.
MATERIALS AND METHODS
We piloted a retrospective study among 50 subjects of both the genders, who had peri-implantitis and underwent soft-tissue grafting done at the department. The ethics clearance was obtained for the study and the patients were contacted over phone and the verbal consent was taken. The data were collected from subjects who had implants placed and were affected with peri-implantitis between the years 2010 and 2020. Of the 50 subjects, 69 implants were placed in all the 4 quadrants. The submucosal grafting was done by the inlay and the onlay methods after a thorough curettage with the ultrasonics was done following all the surgical guidelines. The analgesics and the antibiotics were prescribed after the procedure.
The clinical parameters that were considered in the present study were “width and mobility of keratinized mucosa, pocket probing depth, and bleeding on probing.” The data were compared between the baseline and the follow-up years. IBM SPSS Statistics for Windows, version XX (IBM Corp., Armonk, N.Y., USA VERSION 26.0) was used for the analysis, and analysis of variance test was applied deliberating P < 0.05 as significant.
RESULTS
We observed that of the 50 subjects, majority were women, and the mean age of the subjects was 47 ± 0.25 years. The implants were all successful. The majority of the biotypes of the soft tissue were thin (62 implants).
The keratinized mucosa widths at each implant, at the baseline, and after grafting were 0.3 ± 0.1 mm and 4.2 ± 0.75 mm, respectively. The mobility of the keratinized mucosa was seen in the greater number of the cases (N = 50) at the baseline than at the end of the grafting (N = 2). These two cases recorded slight mobility.
The probing pocket depths at the baseline and after grafting were 6.2 ± 1.1 mm and 4.2 ± 1.75 mm, respectively.
We observed the suppuration at the baseline, and at the end of the grafting during the follow-ups, it was recorded in 15, 0 cases respectively which was significant.
Our findings show that bleeding on probing was seen at the baseline and the follow-ups after the grafting are 41 and 1, respectively. There was a significant variation for all the parameter.[Table 1]
Table 1.
Comparison of the various clinical and demographic parameters
| Parameter | Value | P | |
|---|---|---|---|
| Age (mean) | 47±0.25 | - | |
| Male: female | 21:29 | 0.125 | |
|
| |||
| Clinical values | At baseline | After grafting | P |
|
| |||
| Width of the KM (mm) | 0.3±0.1 | 4.2±0.75 | 0.001 |
| Mobility of the keratinized mucosa (present - n) | 50 | 2 | 0.01 |
| Pocket probing depth | 6.2±1.1 | 4.21±1.75 | 0.04 |
| Bleeding on probing (present - n) | 41 | 1 | <0.001 |
| Suppuration | 15 | 0 | <0.001 |
KM: Keratinized Mucosa
DISCUSSION
There is no gold standard treatment proposed for the peri-implantitis to date. There are both the regenerative and resective surgical procedures for the treatment of the inflammation around the implant.[3,4,5,6] The decision to select the optimal procedure for the treatment lies with the clinician. The soft-tissue grafting is the most common method that can be used with both the above procedures as a combination.
The procurement of this soft-tissue graft is relatively easy and less technique sensitive. The palate is the most common site of the graft procurement.[7] The findings of our study state that there was an improvement of all the clinical characterstics like the width and mobility of keratinized mucosa increased significantly, pocket probing depth, and bleeding on probing lowered significantly. There is no literature to compare our findings as it is one of the first to evaluate the soft-tissue grafting retrospectively. The soft-tissue grafts are of great significance in the areas when the implants are placed in the unfavorable bone structures and the peri-implant periodontal health conditions like recession, as the incidence of the peri-implantitis is increased in these conditions.
There were, however, few limitations in our study. There were no controls to compare our data as the study was retrospective. There were no data of the type of the implant, and the companies of the implants varied between the subjects. Furthermore, there was a great variation of the follow-up for the subjects.
CONCLUSIONS
Within the limitations of our study, we can conclude that the soft-tissue grafting may aid in the treatment of the peri-implantitis along with the routine procedures. Further prospective studies are suggested to corroborate our findings.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Atieh MA, Alsabeeha NH, Faggion CM, Jr, Duncan WJ. The frequency of peri-implant diseases: A systematic review and meta-analysis. J Periodontol. 2013;84:1586–98. doi: 10.1902/jop.2012.120592. [DOI] [PubMed] [Google Scholar]
- 2.Mombelli A, Müller N, Cionca N. The epidemiology of peri-implantitis. Clin Oral Implants Res. 2012;23(Suppl 6):67–76. doi: 10.1111/j.1600-0501.2012.02541.x. [DOI] [PubMed] [Google Scholar]
- 3.Swierkot K, Lottholz P, Flores-de-Jacoby L, Mengel R. Mucositis, peri-implantitis, implant success, and survival of implants in patients with treated generalized aggressive periodontitis: 3- to 16-year results of a prospective long-term cohort study. J Periodontol. 2012;83:1213–25. doi: 10.1902/jop.2012.110603. [DOI] [PubMed] [Google Scholar]
- 4.Albrektsson T, Buser D, Chen ST, Cochran D, DeBruyn H, Jemt T, et al. Statements from the Estepona consensus meeting on peri-implantitis, February 2-4, 2012. Clin Implant Dent Relat Res. 2012;14:781–2. doi: 10.1111/cid.12017. [DOI] [PubMed] [Google Scholar]
- 5.Khoshkam V, Chan HL, Lin GH, MacEachern MP, Monje A, Suarez F, et al. Reconstructive procedures for treating peri-implantitis: A systematic review. J Dent Res. 2013;92:131S–8S. doi: 10.1177/0022034513509279. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Lang NP, Wilson TG, Corbet EF. Biological complications with dental implants: Their prevention, diagnosis and treatment. Clin Oral Implants Res. 2000;11(Suppl 1):146–55. doi: 10.1034/j.1600-0501.2000.011s1146.x. [DOI] [PubMed] [Google Scholar]
- 7.Seibert JS, Louis JV. Soft tissue ridge augmentation utilizing a combination onlay-interpositional graft procedure: A case report. Int J Periodontics Restorative Dent. 1996;16:310–21. [PubMed] [Google Scholar]